What is ICD-10 code T86.31?

T86.31 is the ICD-10-CM diagnosis code for Heart-lung transplant rejection. The recipient's immune system attacks and damages the transplanted heart and lungs, causing them to fail. It belongs to the ICD-10-CM chapter for injury, poisoning and certain other consequences of external causes (s00-t88). T86.31 is a billable code, meaning it can be reported on a claim as a primary or secondary diagnosis when supported by documentation. T86.31 is part of the FY2026 ICD-10-CM code set published by the CMS National Center for Health Statistics and used on Medicare, Medicaid, and commercial claims in the United States.

Yes. T86.31 is a billable ICD-10-CM code that can be reported on professional and institutional claims as a primary or secondary diagnosis when the provider documentation supports the specific condition described. Billable codes in ICD-10-CM are coded to the highest level of specificity available for the documented diagnosis. T86.31 is current for fiscal year 2026 and remains in the active CMS ICD-10-CM code set published by the National Center for Health Statistics.

Which HCC does T86.31 map to under V28?

T86.31 maps to CMS-HCC V28 221 (Heart Transplant Status/Complications). The category number and label come from the CMS-HCC V28 model file for payment year 2026.

What does T86.31 pay in RAF?

T86.31 carries a community, non-dual, aged (CNA) RAF weight of 1.053 under CMS-HCC V28 for payment year 2026. The weight comes from the CMS V28 relative-factor file, not a hand-typed table.

What is the V28 vs V24 difference for T86.31?

CMS phased in the V28 risk adjustment model over payment years 2024 (33%), 2025 (67%), and 2026 (100%), replacing V24. V28 consolidates HCC categories, removes some lower-acuity conditions, and recalibrates RAF weights across the entire model. For T86.31, V28 maps to Heart Transplant Status/Complications at RAF 1.053 while V24 mapped to Major Organ Transplant or Replacement Status at RAF 0.832. Both models can still appear in legacy data and in payer-specific lookback periods.

What documentation supports T86.31?

Document the timeframe of rejection (hyperacute, acute, or chronic) if available for clinical clarity Rejection is a common complication; ensure it is clearly documented in the medical record before coding Because T86.31 maps to a payment HCC, the documentation must also satisfy MEAT criteria (Monitor, Evaluate, Assess, or Treat) for the encounter to count toward the patient's risk adjustment score. See the MEAT criteria checklist at /meat-criteria for what Monitor, Evaluate, Assess, or Treat looks like in a note. MEAT is generic documentation evidence, not a payer-specific rule.

2026 ICD-10-CM T86.31: Heart-lung transplant

T86.31 maps to CMS-HCC V28 221 (RAF 1.053). Documentation must support MEAT. MEAT criteria · RAF calculator · HCC coding software

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Code lookupT86.31Effective periodFY2026 Apr Update (Apr 1-Sep 30)

FY 2026 Apr update / Injury, poisoning and certain other consequences of external causes (S00-T88) / Complications of surgical and medical care, not elsewhere classified (T80-T88)

T86.31

Billable / SpecificICD-10-CMOfficial ICD-10-CMCodebook guidance

Heart-lung transplant rejection

The recipient's immune system attacks and damages the transplanted heart and lungs, causing them to fail.

Buddy Insight

CMS-HCC V28

Mapped

HCC 221

Heart Transplant Status/Compl...

RAF 1.053

+ HCC 276

CMS-HCC V24

Mapped

HCC 186

Major Organ Transplant or Rep...

RAF 0.832

ACA/HHS

Mapped

HCC 129, 158

HHS-HCC 129, 158

Varies by metal level

ESRD/PACE

Mapped

HCC 186

Major Organ Transplant or Rep...

RAF 0.138

RXHCC

Mapped

HCC 396

Allograft Complications

Not separately weighted

Code Book Path

Official

T86Complications of transplanted organs and tissue

T86.3Complications of heart-lung transplant

T86.31Heart-lung transplant rejection

Inclusion Terms

Official

ICD-10-CM does not list inclusion terms for T86.31 in this effective period.

Excludes 2

Official

ICD-10-CM does not list Excludes 2 notes for T86.31 in this effective period.

Related Child Codes

Official

T86.30Unspecified complication of heart-lung transplant

T86.32Heart-lung transplant failure

T86.33Heart-lung transplant infection

T86.39Other complications of heart-lung transplant

Includes

Official

ICD-10-CM does not list Includes notes for T86.31 in this effective period.

Excludes 1

Official

ICD-10-CM does not list Excludes 1 notes for T86.31 in this effective period.

Code First

Official

ICD-10-CM does not list Code First sequencing instructions for T86.31 in this effective period.

Use Additional

Official

ICD-10-CM does not list Use Additional Code instructions for T86.31 in this effective period.

Code Also

Official

ICD-10-CM does not list Code Also instructions for T86.31 in this effective period.

Buddy Documentation Tip

HCC Buddy guidance

History of heart-lung transplant with transplant date

Evidence of rejection in heart, lungs, or both organs

Biopsy results from endomyocardial or transbronchial sampling

Clinical symptoms affecting cardiac and/or pulmonary function

MEAT Support

HCC Buddy guidance

History of heart-lung transplant with transplant date

Evidence of rejection in heart, lungs, or both organs

Biopsy results from endomyocardial or transbronchial sampling

Clinical symptoms affecting cardiac and/or pulmonary function

Audit Caution

HCC Buddy guidance

Using single-organ rejection codes for combined heart-lung rejection

Confusing with acute exacerbation of underlying conditions

Missing the dual-organ nature of the rejection process

Using failure codes when active rejection is being treated

Common Mistakes

HCC Buddy guidance

T86.30 — Unspecified heart-lung transplant complication (when rejection documented)

T86.21 — Heart transplant rejection (single organ vs combined)

T86.811 — Lung transplant rejection (single organ vs combined)

T86.32 — Heart-lung transplant failure (active rejection vs end-stage)

Current with CMS: FY2026 ICD-10-CM Apr 1 update (effective Apr 1 – Sep 30, 2026) · CMS-HCC V28, 100% phased in for payment year 2026. FY2027 code set already staged for October 1, 2026. How HCC Buddy stays current →

Is T86.31 an HCC code?

Yes. T86.31 (Heart-lung transplant rejection) maps to Heart Transplant Status/Complications under the CMS-HCC V28 risk adjustment model (and Major Organ Transplant or Replacement Status under V24), with a community non-dual aged RAF of 1.053. It is billable for payment year 2026.

Coder answer: T86.31 is billable and maps to V28 HCC 221, Heart Transplant Status/Complications. Open it in the Code Book for the tabular path, RAF, and MEAT checklist.

Code: T86.31
Description: Heart-lung transplant rejection
HCC (V28): HCC 221 — Heart Transplant Status/Complications
RAF: 1.053
Billable: Yes
Payment year: 2026

HCC Category Mapping

V28HCC 221, Heart Transplant Status/Complications

1.053

+ HCC 276, Lung Transplant Status/Complications2.531

V24HCC 186, Major Organ Transplant or Replacement Status

0.832

ESRDHCC 186, Major Organ Transplant or Replacement Status

0.138

RxHCCHCC 396, Allograft Complications

Not separately weighted

Each model's RAF is its CMS base weight for that model's standard population, so weights are not directly comparable across models: CMS-HCC V28 and V24 use Community, Non-Dual, Aged; ESRD uses the dialysis continuing-enrollee model; RxHCC is the Part D continuing-enrollee, non-low-income, aged weight (a larger scale than CMS-HCC). ACA/HHS has no single weight — it varies by metal level. Actual per-patient RAF contribution depends on member segment, interactions, and the model year used by the payer. V28 is the CMS-HCC model phased in over payment years 2024–2026; V24 remains in use during the transition and for historical data.

Work T86.31 in the Code Book — tabular path, V28 RAF, and MEAT checklist →

MEAT Criteria for T86.31

For T86.31 to count as a valid HCC diagnosis in a given encounter, the provider's documentation must show MEAT: Monitor, Evaluate, Assess, or Treat. A diagnosis from a prior year does not carry forward automatically, it has to be re-documented and supported each calendar year.

MMonitor: signs, symptoms, disease progression, or lab trending documented in the note
EEvaluate: test results, medication response, or physical findings reviewed by the provider
AAssess: explicit mention in the assessment or plan with acknowledgment of status
TTreat: medication, referral, procedure, therapy, or counseling tied to the diagnosis

Only one of M/E/A/T is required to support the code, but the documentation must be specific enough to show that the provider actually addressed T86.31 during that encounter, not just copy-forwarded from a problem list.

Coder workflow notes

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What This Code Means

T86.31 is the ICD-10-CM diagnosis code for heart-lung transplant rejection. The recipient's immune system attacks and damages the transplanted heart and lungs, causing them to fail. T86.31 sits in the ICD-10-CM chapter for injury, poisoning and certain other consequences of external causes (s00-t88), within the section covering complications of surgical and medical care, not elsewhere classified (t80-t88).

Under the CMS-HCC V28 risk adjustment model, T86.31 maps to Heart Transplant Status/Complications (HCC 221) with a community, non-dual, aged base RAF weight of 1.053. Under the older CMS-HCC V24 model, T86.31 maps to Major Organ Transplant or Replacement Status (HCC 186) with a community, non-dual, aged base RAF weight of 0.832. V28 is the CMS-HCC risk adjustment model that reached 100% phase-in for payment year 2026, replacing V24 which was used during the PY2024–PY2025 transition.

Document the timeframe of rejection (hyperacute, acute, or chronic) if available for clinical clarity. Because T86.31 maps to a payment HCC, the provider's documentation must satisfy MEAT criteria (Monitor, Evaluate, Assess, or Treat) for the encounter to count toward the patient's Medicare Advantage risk adjustment score. When documentation is ambiguous, coders should issue a provider query rather than assume the highest-specificity variant.

HCC Buddy maintains structured V28 and V24 mapping, RAF weights, and MEAT documentation criteria for T86.31 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.

Coding Tips

•Document the timeframe of rejection (hyperacute, acute, or chronic) if available for clinical clarity
•Rejection is a common complication; ensure it is clearly documented in the medical record before coding

Clinical Significance

Heart-lung transplant rejection represents simultaneous rejection of both organs, creating a life-threatening emergency requiring immediate aggressive intervention to prevent dual organ failure and death. The complexity of managing rejection in both cardiac and pulmonary systems simultaneously requires specialized transplant expertise and intensive monitoring.

Documentation Requirements

✓History of heart-lung transplant with transplant date
✓Evidence of rejection in heart, lungs, or both organs
✓Biopsy results from endomyocardial or transbronchial sampling
✓Clinical symptoms affecting cardiac and/or pulmonary function
✓Pulmonary function tests and cardiac assessment results
✓Anti-rejection therapy protocols administered
✓Response to treatment and serial monitoring results
✓Coordinated care between cardiac and pulmonary transplant teams

Commonly Confused Codes

•T86.30: Unspecified heart-lung transplant complication (when rejection documented)
•T86.21: Heart transplant rejection (single organ vs combined)
•T86.811: Lung transplant rejection (single organ vs combined)
•T86.32: Heart-lung transplant failure (active rejection vs end-stage)
•J44.0: COPD with acute exacerbation (pulmonary symptoms)